Medical Media Images

Thoracic Fibromyalgia

What does Fibromyalgia mean?

The term fibromyalgia is a combination of the Latin word “fibro” which means fibrous (fibers) tissue and the Greek words of “myo” (muscle) and “algia” (pain). Altogether, the word means “pain of the fibrous tissue and muscle”.

What is Fibromyalgia?

Fibromyalgia is a disease which causes widespread muscle pain often accompanied by fatigue, and problems with sleep, memory and mood issues. Patients may feel more pain with pressure over a muscle than would be expected (allodynia). Some patients also have difficulty with concentration, memory and mental performance. These symptoms can follow physical or emotional trauma, but can also occur slowly over time without a specific event.

How many people suffer from Fibromyalgia?

It is estimated that fibromyalgia affects up to 2-4% of the population, which is an astounding statistic. Females are 9 times more likely to be affected by this disease than men.

Is Fibromyalgia a disease?

Initially fibromyalgia was not thought to be a disease. However, after lengthy studies, the Institutes of Health and the American College of Rheumatology finally made fibromyalgia a specific disease. The disease is defined as a condition of the central nervous system (brain and spinal cord) which affects the body’s physiology, namely muscle and fiber tissue.

What is the cause of Fibromyalgia?

The cause of fibromyalgia is unknown. The following are some hypotheses as what could be causing it:

  1. Genetic inheritance:

There is some evidence that fibromyalgia can run in families.

      2. Stress:

There is some evidence that patients suffering from chronic fatigue syndrome, irritable bowel syndrome and post-traumatic stress disorder are more likely to have fibromyalgia.

      3. Dopamine and Serotonin:

Some researchers believe that there is a problem with dopamine or serotonin which are common transmitters of nerve information in the brain.

      4. Depression:

There appears to be strong evidence of the role of depression in patients with fibromyalgia.

How is Fibromyalgia diagnosed?

There is no single test which can definitively diagnose fibromyalgia. Since the symptoms can appear similar to arthritic conditions or muscle diseases, these conditions are often ruled out first. This can make the diagnosis of fibromyalgia a “diagnosis of exclusion”, meaning that it seems to be the most plausible condition after others are eliminated.

There are some guidelines for criteria to help diagnose fibromyalgia. These were published by the American College of Rheumatology in 1990:

  1. A history of widespread pain lasting more than 3 months which affects all four “quadrants” (corners) of our body, i.e. both sides, above and below our waist.
  2. Pain in at least 11 of 18 established tender points. These tender points are identified by specific locations. Often the physician puts pressure on these points and evaluates the response as painful or not.

What is the treatment of Fibromyalgia?

At present there is no cure for fibromyalgia. The following are some suggest treatment methods to help with the symptoms. They may help alone or in combination:

  1. Psychological Therapies

Cognitive behavioral therapy (CBT) is a psychological treatment where the therapist and patient work together to overcome problems by changing the thinking, behavior and emotional response or the patient. CBT in combination with exercise seems to be a promising combination.

      2. Medication Management

There are 3 medications which are approved by the FDA for the treatment of fibromyalgia:

a. Pregabalin (Lyrica)

This medication was the first one approved by the FDA in 2007 for the treatment of fibromyalgia. It is also used for nerve pain and seizure disorders.

b. Duloxetine (Cymbalta)

This medication was approved by the FDA in 2008 for the treatment of fibromyalgia. It is also used for anxiety and depression. Duloxetine increases the levels of norepinephrine and serotonin (transmitters of nerve signals) in the brain.

c. Milnacipran (Savella)

This medication was approved by the FDA in 2009 for the treatment of fibromyalgia. It works in a similar way to Duloxetine by increasing levels of nerve transmitters in the brain.

d. Antidepressants (link to antidepressants)

A number of antidepressants have also shown usefulness in the treatment of fibromyalgia. They include amongst others Fluoxetine (Prozac), Paroxetine (Paxil), and Amitriptyline (Elavil).

e. Nerve Pain Medications (link to nerve pain medications)

In addition to Pregabalin (Lyrica), Gabapentin (Neurontin) is also used in the treatment of fibromyalgia. It is FDA approved for the treatment of nerve pain, not specifically fibromyalgia.

f. Pain Killers (link to pain killers)

Narcotic pain killers have not been proven to help in fibromyalgia. It should only be used when other treatment have failed.

Tramadol (Ultram) has been found to be moderately effective in the treatment of fibromyalgia.

      3. Injections

Trigger Point Injections can be helpful.

      4. Physical Therapy (PT) and Exercises

There is some evidence that cardiovascular exercises are effective in the treatment of fibromyalgia, especially in combination with cognitive therapy (CBT).

Aquatic therapy in warm water has also been shown to be useful.

General PT with a focus on relaxation exercises, muscle and fascia mobilization amongst others can help as well.

     5. Massage Therapy

Massage Therapists have techniques which can complement the medical care for the symptoms from Fibromyalgia.

      6. Chiropractic Care

Chiropractic spine manipulation can help with any potential spine contributors to the Fibromyalgia